Quick Test May Help Prevent Hospital Delirium, Researchers Say

Once identified, these patients can receive preventive care

By Robert Preidt

Thursday, August 8, 2013

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THURSDAY, Aug. 8 (HealthDay News) -- As many as one in five hospital patients develops severe confusion, or delirium, often prolonging hospital stays and increasing health care costs. Now, a simple test can help predict who's most at risk, a new study finds.
"It's estimated that up to one-third of hospital-acquired delirium cases could be prevented with appropriate interventions, but those interventions are resource-intense and can't be applied to everyone," study lead author Dr. Vanja Douglas, an assistant professor of clinical neurology at the University of California, San Francisco, said in a university news release.
"Our objective was to develop a tool to predict delirium using elements that could be assessed quickly in the fast-paced environment of a hospital," Douglas said. "The new tool can be completed by a nurse in two minutes, and provides a clinically useful and practical alternative to existing delirium prediction models."
The tool was tested in 374 patients older than 50 who did not have delirium when they were admitted to hospital. The tool is called AWOL, which stands for age (A), unable to spell "world" backward (W), not fully oriented to place (O), and moderate to severe illness (L).
Patients with higher AWOL scores were more likely to develop delirium. Once identified, those patients can receive specialized care to prevent delirium, suggests the study, published online Aug. 7 in the Journal of Hospital Medicine.
The exact sequence of events that occurs in the body and brain and causes delirium is not well understood, the researchers noted. It is believed that a combination of being older and having an acute illness creates an imbalance of neurotransmitters in the brain that leads to delirium. Powerful medications such as narcotics also contribute to the problem.
Hospital delirium tends to develop rapidly and can lead to death. Known risk factors for delirium include: older age; preexisting thinking problems; dehydration; severe illness; vision and hearing impairment; electrolyte abnormalities; and overmedication.

SOURCE: University of California, San Francisco, news release, Aug. 7, 2013

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